scholarly journals Epidemiological Survey of Head and Neck Injuries and Trauma in the United States

2014 ◽  
Vol 151 (5) ◽  
pp. 776-784 ◽  
Author(s):  
Rosh K. V. Sethi ◽  
Elliott D. Kozin ◽  
Peter J. Fagenholz ◽  
Daniel J. Lee ◽  
Mark G. Shrime ◽  
...  
Keyword(s):  
Head And Neck ◽  
Case Series ◽  
The United States ◽  
Epidemiological Survey ◽  
Common Procedure ◽  
Weighted Estimates ◽  
Patient Disposition ◽  
Depth Analysis ◽  
The Us ◽  
Life Threatening

Objective Head and neck trauma results in a range of injuries, spanning minor lacerations to life-threatening airway compromise. Few studies provide in-depth analysis of injuries to the head and neck (HN). We aim to (1) describe HN injury prevalence in the US and (2) investigate patient disposition and the outcome of mortality. Study Design Case series with chart review. Setting Nationwide emergency department (ED) sample. Methods The 2011 database was queried for encounters with a primary diagnosis of HN injury, as categorized by the Barell Injury Matrix. Weighted estimates for demographics, injury category, and mechanism were extracted. Predictors of mortality and admission were determined by multivariable regression. Results We identified 131 million ED encounters. A weighted total of 5,418,539 visits were related to primary HN injuries. Average age was 30 (SE = 0.4), and 56.8% were male. Sixty-four percent of injuries were attributed to fall or blunt trauma. Open wounds comprised 41.8% of injuries. The most common procedure was laceration repair (70%). The majority of patients (97%) were discharged home. Mortality rate was less than 1%. Predictors of admission and mortality ( P < .05) included multiple trauma, vessel trauma, and burns. Other risk factors included foreign-body, older age, and male gender. Conclusions Primary HN injuries commonly present to emergency rooms in the US. The majority of HN injuries are non–life threatening and do not require admission to the hospital or result in death. These data have implications for HN injury surveillance and may be used to risk-stratify patients who present with injuries in the acute care setting.

Breakthrough Therapy, PRIME and Sakigake: A Comparison Between Neuroscience and Oncology in Obtaining Preferred Regulatory Status

2019 ◽  
pp. 216847901987406 ◽  
Author(s):  
Elena Tomaselli Muensterman ◽  
Yijia Luo ◽  
Jonathon M. Parker
Keyword(s):  
The United States ◽  
Accelerated Programs ◽  
The European Union ◽  
Regulatory Pathways ◽  
Drug Candidates ◽  
Regulatory Status ◽  
The Us ◽  
Life Threatening ◽  
Global Nature ◽  
Increasing Demand

Background: Because of the increasing demand for drugs addressing life-threatening and rare diseases, regulatory agencies have developed a variety of accelerated regulatory pathways. These programs are aimed at prioritizing the most promising drug candidates for diseases lacking satisfactory treatments. The most prominent accelerated programs introduced have been Breakthrough-Therapy Designation (BTD) in the United States, Priority Medicine (PRIME) in the European Union and Sakigake in Japan. This article reviews these designations and looks at differences in how they are granted across the 3 jurisdictions focusing on neuroscience and oncology. Methods: Our objective was to analyze BTD, PRIME, and Sakigake approvals between 2012 and 2019 with a focus on numerical disparities of designations granted between the 2 therapeutic areas. A search of public sources pertaining to topics of BTD, PRIME, and Sakigake was undertaken. Results: This analysis revealed that 48% of BTD were granted in oncology, while neuroscience received 8% of these designations, for PRIME designations were 27% received by oncology and 15% by neuroscience and in Japan, 50% of Sakigake were granted to oncology and 22% to neuroscience products. Conclusion: Given the global nature of drug development and relative similarity of these regulatory mechanisms, there is an apparent disparity between the US granting special status at 6:1 (oncology: neuroscience) and both the EU and Japan granting at 2:1. This disproportionate ratio is likely impacted by multifactorial issues; however, this difference is worth further investigation.

Commentary on “Otolaryngology–Head and Neck Surgery Physician Workforce Issues An Analysis for Future Specialty Planning” by Kim, Cooper, and Kennedy

2012 ◽  
Vol 146 (2) ◽  
pp. 203-205 ◽  
Author(s):  
Shannon P. Pryor ◽  
Linda Brodsky ◽  
Sujana S. Chandrasekhar ◽  
Lauren Zaretsky ◽  
Duane J. Taylor ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
The United States ◽  
Head And Neck Surgery ◽  
Physician Workforce ◽  
Modeling Methods ◽  
The Us ◽  
Workforce Issues ◽  
Time Work ◽  
Part Time

An impending physician shortage has been projected. The article by Kim, Cooper, and Kennedy, titled “Otolaryngology–Head and Neck Surgery Physician Workforce Issues: An Analysis for Future Specialty Planning,” is an attempt to evaluate and address this potential shortage as it applies to otolaryngology. The authors of this comment have concerns about the article’s assumptions, design, and recommendations. Kim et al attempt to extrapolate data from other specialties and other countries to the US otolaryngology workforce, use that data in modeling methods without demonstrated validity, and based on their analysis, they recommend drastic changes to otolaryngologic training and practice in the United States. Particularly troublesome are (1) the emphasis placed on gender and part-time work and (2) the measurement of productivity defined as hours worked per week. Before redefining our specialty, more thorough and systematic data acquisition and review are necessary to meet the needs of our patients now and in the future.

Donald Trump und die Politik in den USA

2020 ◽  
Keyword(s):  
Political Parties ◽  
Security Policy ◽  
The United States ◽  
The Public ◽  
Depth Analysis ◽  
The Us ◽  
Foreign Politics ◽  
Current Events ◽  
Media Politics ◽  
Trump Administration

This edited volume provides the reader with a concise and detailed overview of political developments in the United States since the beginning of the Trump administration. It critically analyses domestic and foreign politics as well as current events, and places them in the wider context of US politics. Its chapters present thorough analyses on domestic and foreign policy issues, for example environmental policy, media politics, economic reforms, transatlantic relations and security policy. The book discusses both the successes and failures of the Trump administration and explores how actors in Congress, the public and in political parties have influenced politics in the US. The aim is to allow for an in-depth analysis of US politics in an age dominated by incessant tweets and changing headlines. With contributions by Philipp Adorf, Florian Böller, Michael Dreyer, Christoph Haas, Steffen Hagemann, Jörg Hebenstreit, Lukas Herr, Curd Knüpfer, Simon Koschut, Christian Lammert, Betsy Leimbigler, Markus Müller, Ronja Ritthaler-Andree, Markus Siewert, David Sirakov, Oliver Thränert, Sarah Wagner, Iris Wurm.

scholarly journals Diverse Caregivers in the United States: Implications for Caregiving Across the Lifespan

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 104-105
Author(s):  
C Grace Whiting ◽  
Rita Choula ◽  
Yanira Cruz ◽  
Lauren Pongan ◽  
Feylyn Lewis
Keyword(s):  
Asian American ◽  
Alaska Native ◽  
Geographic Location ◽  
The United States ◽  
Policy And Practice ◽  
Depth Analysis ◽  
The Us ◽  
Survey Interviews ◽  
Policy Institute ◽  
The Impact

Abstract Caregivers with diverse backgrounds make up an important part of the landscape of caregiving in the US. Their unique experiences have been traditionally under-researched in the field of social sciences and underrecognized by society. To further understand the impact of race, ethnicity, class, gender and sexuality onto caregiving, the National Alliance for Caregiving (NAC) and the AARP Public Policy Institute commissioned an in-depth analysis of the dataset collected from the Caregiving in the US 2020 study, which segments populations based on ethnic and sexual identity, geographic location, and income level. Utilizing survey interviews with 1,392 caregivers in the US, this study found differences amongst the African-American, Latinx, and Asian American-Pacific Islander populations in relation to age, time spent caregiving, ADL/IADLs, caregiving strain and intensity, receipt of formal and informal support, and financial impact. In consideration of the distinct challenges presented by diverse caregiving throughout the lifespan, this presentation will also feature results from a 2020-2021 Diverse Elders Coalition and NAC commissioned study on the unmet caregiving needs in diverse communities. 11 virtual listening sessions were held with 400 caregivers of color, including American Indian/Alaska Native caregivers, and LGBTQ caregivers across the nation. Presentation attendees can expect to learn new insights into the experiences of diverse caregivers, while also gaining a fresh understanding of informal and formal support preferences with a multicultural lens. Finally, this presentation will provide recommendations to further prioritize the needs of historically marginalized caregivers in policy and practice.

scholarly journals Differences inRhodococcus equiInfections Based on Immune Status and Antibiotic Susceptibility of Clinical Isolates in a Case Series of 12 Patients and Cases in the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Praveen Gundelly ◽  
Yasuhiro Suzuki ◽  
Julie A. Ribes ◽  
Alice Thornton
Keyword(s):  
Antibiotic Susceptibility ◽  
Immune Status ◽  
Case Series ◽  
Clinical Isolates ◽  
Immunocompromised Patients ◽  
Hiv Patients ◽  
Zoonotic Pathogen ◽  
The Us ◽  
Life Threatening ◽  
Immunocompetent Patients

Rhodococcus equiis an unusual zoonotic pathogen that can cause life-threatening diseases in susceptible hosts. Twelve patients withR. equiinfection in Kentucky were compared to 137 cases reported in the literature. Although lungs were the primary sites of infection in immunocompromised patients, extrapulmonary involvement only was more common in immunocompetent patients (P<0.0001). Mortality inR. equi-infected HIV patients was lower in the HAART era (8%) than in pre-HAART era (56%) (P<0.0001), suggesting that HAART improves prognosis in these patients. Most (85–100%) of clinical isolates were susceptible to vancomycin, clarithromycin, rifampin, aminoglycosides, ciprofloxacin, and imipenem. Interestingly, there was a marked difference in susceptibility of the isolates to cotrimoxazole between Europe (35/76) and the US (15/15) (P<0.0001). Empiric treatment ofR. equiinfection should include a combination of two antibiotics, preferably selected from vancomycin, imipenem, clarithromycin/azithromycin, ciprofloxacin, rifampin, or cotrimoxazole. Local antibiograms should be checked prior to using cotrimoxazole due to developing resistance.

scholarly journals Unexpected complications with head and neck hydrogel microsphere particle embolization: A case series and a technical note

2016 ◽  
Vol 23 (1) ◽  
pp. 107-111 ◽  
Author(s):  
Naim N Khoury ◽  
Pierre-Olivier Champagne ◽  
Marc Kotowski ◽  
Jean Raymond ◽  
Daniel Roy ◽  
...  
Keyword(s):  
Polyvinyl Alcohol ◽  
Head And Neck ◽  
Cranial Nerves ◽  
Case Series ◽  
Technical Note ◽  
Common Procedure ◽  
Ischemic Complications ◽  
Hydrogel Microsphere ◽  
Polyvinyl Alcohol Particles ◽  
Hydrogel Microspheres

Endovascular particle embolization is a common procedure with a relatively safe profile. We report here four cases in which cranial nerves, skin and mucosal ischemic complications occurred with the use of hydrogel microspheres (250–500 µm in size). Given the compressibility and higher penetration potential of microsphere particles compared with polyvinyl alcohol particles of similar size, we suggest oversizing hydrogel microsphere particles for head and neck embolizations.

scholarly journals Transfusion-related red blood cell alloantibodies: induction and consequences

Blood ◽  
2019 ◽  
Vol 133 (17) ◽  
pp. 1821-1830 ◽  
Author(s):  
Christopher A. Tormey ◽  
Jeanne E. Hendrickson
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Blood Product ◽  
The United States ◽  
Mitigation Strategies ◽  
Common Procedure ◽  
Missed Opportunities ◽  
Life Saving ◽  
Life Threatening ◽  
Clinically Significant

Abstract Blood transfusion is the most common procedure completed during a given hospitalization in the United States. Although often life-saving, transfusions are not risk-free. One sequela that occurs in a subset of red blood cell (RBC) transfusion recipients is the development of alloantibodies. It is estimated that only 30% of induced RBC alloantibodies are detected, given alloantibody induction and evanescence patterns, missed opportunities for alloantibody detection, and record fragmentation. Alloantibodies may be clinically significant in future transfusion scenarios, potentially resulting in acute or delayed hemolytic transfusion reactions or in difficulty locating compatible RBC units for future transfusion. Alloantibodies can also be clinically significant in future pregnancies, potentially resulting in hemolytic disease of the fetus and newborn. A better understanding of factors that impact RBC alloantibody formation may allow general or targeted preventative strategies to be developed. Animal and human studies suggest that blood donor, blood product, and transfusion recipient variables potentially influence which transfusion recipients will become alloimmunized, with genetic as well as innate/adaptive immune factors also playing a role. At present, judicious transfusion of RBCs is the primary strategy invoked in alloimmunization prevention. Other mitigation strategies include matching RBC antigens of blood donors to those of transfusion recipients or providing immunomodulatory therapies prior to blood product exposure in select recipients with a history of life-threatening alloimmunization. Multidisciplinary collaborations between providers with expertise in transfusion medicine, hematology, oncology, transplantation, obstetrics, and immunology, among other areas, are needed to better understand RBC alloimmunization and refine preventative strategies.

scholarly journals Transport of patients with giant disfiguring cranial tumors from Africa to the US for collaborative multidisciplinary treatment

2021 ◽  
Vol 12 ◽  
pp. 175
Author(s):  
Eric Nussbaum ◽  
Patrick Graupman ◽  
Martin Lacey ◽  
Andrew Harrison ◽  
Jodi Lowary ◽  
...  
Keyword(s):  
Medical Care ◽  
Multidisciplinary Treatment ◽  
Plexiform Neurofibroma ◽  
Osteogenic Sarcoma ◽  
Case Series ◽  
The United States ◽  
Ossifying Fibroma ◽  
Surgical Team ◽  
The Us ◽  
Access To Medical Care

Background: Giant disfiguring cranial tumors are exceptionally rare and develop over the course of many years, typically in patients who lack access to medical care. Here, we describe four patients who were flown to our center for treatment by a multidisciplinary surgical team, who had previously been turned down for treatment at multiple international centers in Africa, Europe, and the United States (US) due to complexity and financial concerns. The case series describes socioeconomic implications and the feasibility of offering such care to patients from outside the US. Case Descriptions: Four patients with giant skull disfiguring tumors were flown internationally and treated by a surgical team consisting of a complex cranial neurosurgeon, a craniofacial reconstructive plastic surgeon, and an oculoplastic surgeon. All patients underwent aggressive surgical therapy with the aim of complete tumor removal and simultaneous cranial reconstruction. A patient with osteogenic sarcoma underwent two additional resections in 3 years, with delayed reconstruction. They returned home but ultimately succumbed to the disease. A patient with ossifying fibroma required two follow-up procedures for cosmetic reconstruction and sought asylum in the US, where they remain today. Two additional patients, one with a giant plexiform neurofibroma and one with a cerebellopontine angle meningioma, achieved good results and returned to Africa 1 month and 3 weeks after surgery, respectively. Conclusion: Resection of giant disfiguring cranial tumors and reconstruction of the impacted region requires an experienced multidisciplinary team. These cases can be managed by transporting such patients from areas without access to medical care to specialized centers able to provide excellent care.

Complications of Cosmetic Surgery Tourism: Case Series and Cost Analysis

2020 ◽  
Author(s):  
Chelsea Venditto ◽  
Margaret Gallagher ◽  
Patrick Hettinger ◽  
Robert Havlik ◽  
Rakel Zarb ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Cosmetic Surgery ◽  
Private Insurance ◽  
Case Series ◽  
The United States ◽  
Financial Loss ◽  
Level Of Evidence ◽  
The Us ◽  
Mean Cost ◽  
Operating Surgeon

Abstract Background Cosmetic surgery tourism is increasing exponentially. Patients seek cosmetic procedures within the United States and abroad, lured by lower cost procedures, shorter waiting lists, and affordable airfare and hotel accommodations. Unfortunately, operations are often performed by non–board-certified plastic surgeons, sometimes not even by plastic surgeons. Preoperative counseling, frequently limited to a video-chat with an office secretary, provides inadequate discussion regarding potential complications. Postoperative care is careless and rarely involves the operating surgeon. Complications are frequent, with management falling into the hands of plastic surgeons unfamiliar with the patient’s care. Furthermore, the physician, rather than the patient or hospital, faces the largest cost burden. Objectives The authors sought to explore their institution’s experience treating complications of cosmetic tourism and investigate associated costs. Methods The retrospective review of 16 patients treated for complications related to cosmetic surgery tourism plus cost analysis revealed a substantial discrepancy between money saved by undergoing surgery abroad and massive costs accrued to treat surgical complications. Results The most common complication was infection, often requiring surgery or IV antibiotics on discharge. Mean cost per patient was $26,657.19, ranging from $392 (single outpatient visit) to $154,700.79 (prolonged admission and surgery). Overall, the hospital retained 63% of billed charges, while physicians retained only 9%. The greatest amount paid by any single patient was $2635.00 by a patient with private insurance. Conclusions Cosmetic tourism has severe medical repercussions for patients and complications that burden hospitals, physicians, and the US medical system. Physicians treating the complications suffer the greatest financial loss. Level of Evidence: 4

Integrative Gastroenterology

2019 ◽  
Keyword(s):  
Fast Food ◽  
Digestive Disease ◽  
The United States ◽  
Lifestyle Modifications ◽  
Us Economy ◽  
Digestive Diseases ◽  
High Prevalence ◽  
The Us ◽  
Life Threatening ◽  
Personalized Approach

Digestive diseases encompass numerous acute and chronic conditions of the gastrointestinal tract, ranging from common digestive disorders to serious, life-threatening diseases. Over 60 million Americans are afflicted with known digestive diseases with the association of many other adverse health conditions and disability. The annual economic impact on the US economy is more than $141 billion. The Western diet and lifestyle contribute to this high prevalence of digestive disease in America and worldwide. The most common digestive conditions in the United States, Canada, and Europe were uncommon in Asia and Africa until recently with the expansion of fast-food franchises and heightened availability of processed foods worldwide. Digestive diseases have a complex underlying pathogenesis that involves a number of influences, including environmental factors, genetics, inflammation, and the gut microbiome. The risk of developing digestive disease is adjustable by making key dietary and lifestyle modifications. Adopting a personalized approach to digestive illness can achieve improved patient satisfaction and quality of life for patients.

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